The lifecycle of an income protection insurance claim

If you work for a living, any interruption of your regular income is likely to cause problems. Getting ill or injured can mean taking weeks or months off work. Unless you have substantial savings that you don’t mind touching, or generous sick pay from your employer, income protection could be the best way to keep the money coming in. It’s an insurance policy you buy when you’re fit and working, paid for with monthly premiums. If you’re forced to stop working you can claim a replacement income to see you through your recovery. So, what happens when it’s time to make a claim?

How to claim on income protection insurance

It’s worth making yourself familiar with the income protection claim process before you need to use it. That way there shouldn’t be any major surprises. Your expectations of how long it takes and what you need to do will be realistic.

Your policy document explains your insurer’s claims process. It’s a good idea to read this carefully and ask your insurer about any terms or steps you don’t understand. Some of the language may need clarification, such as ‘waiting period’, ‘benefit period’ and ‘med3 certificate’. Claiming income protection insurance may involve a lot of paperwork but if you keep these steps in mind it needn’t be difficult.

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You slip, fall and break your leg. Or you visit the doctor and are diagnosed with clinical depression. Or you develop a severe ear infection like labyrinthitis that affects your balance and makes you nauseous. If you experience anything that could force you to stop working for weeks or even months, what’s the first thing to do?

Your insurer will expect you to tell them as soon as possible that you’ve suffered an illness or injury that’s likely to lead to a claim, so you should notify them before you start the formal process of claiming.

Before you fill in the claim form it’s worth checking the key terms – the waiting period before your benefit payments begin and the benefit period, which is how long those payments could last. You should also make sure your illness or injury doesn’t fall under one of the policy exclusions.

When you submit your claim form, you’ll need to give supporting evidence of your income (payslips, P60) and possible of the fact that you’ve lost it, such as written confirmation from your employer that you’re not working. If you’re self-employed, of course, you’re the only person who can confirm this.

You’ll also need to supply proof of your illness or injury. Many insurers are happy for you simply to state this yourself for the first seven days. This is known as self-certification. After the first week you’ll usually need to send a Med3 certificate signed by a doctor or healthcare professional, one for each subsequent week that you’re off work. This is in line with your normal obligation to give continuing, formal proof to your employer.

Your policy may give you guidance on how quickly you should send all the information. If you’re slow to do this is could delay the assessment and payment of your claim.

Your insurer will now start to assess your claim. In some cases, they may ask for supplementary information, such as additional details from your medical records. You’ll need to give them the authority to request this from your GP. 

Occasionally an insurer will ask you to see a medical professional or some other qualified person of their own choosing. Policies usually make this a condition of your insurance so it’s in your interest to comply as quickly as possible.

As part of the assessment process, the insurer will check your entitlement. Most of the time this should be the full amount you expect to receive but in some cases the benefit you get may be reduced if you have financial support from other sources, like employer sick pay or another income protection policy. Similarly, if your income has gone down since you took out your policy you may receive less than the amount you were banking on. If you’re receiving Statutory Sick Pay or state benefits your payments usually won’t be affected.

Your benefit amount could also be affected if your circumstances qualify you for working persons benefit or house persons benefit. You’ll find an explanation of these terms here.

If the insurer approves your claim, then you’ll receive the first of your monthly payments at the end of your waiting period. Bear in mind that if you’ve recovered from your illness or injury before the waiting period ends you won’t be due any payment.

If your policy includes a waiver of premium then your premiums will be suspended for as long as you’re being paid. You won’t need to start them again until your benefit payments stop.

Once the payments have started, you’ll need to keep sending weekly Med3 certificates to your insurer. If your circumstances change you should let them know. For example, you might recover partially and decide to go back to work part-time or on restricted duties.

While your claim is being paid your insurer may want to carry out periodic reassessments and will ask you to cooperate in this. They may also offer you rehabilitation services to speed up your recovery.

When you’re able to return to work you need to tell your insurer, at which point your claim will end and your benefit payments will stop. It’s important to remember that your right to benefits ends not when you go back to work but when you’re able to go back to work. If you choose to delay your return once you’re fit, you won’t be entitled to payments.

This isn’t the only event that can bring income protection claims to an end. Your policy sets out the maximum period for which you can be paid under a single claim. This is your benefit period and if it comes to an end while you’re still unable to work, then unfortunately your payments will cease.

It’s also worth pointing out that your payments could be stopped if, while you’re claiming, you don’t comply with your insurer’s requests for information, documentary evidence or participation in health and other checks.

Preparation, communication and honesty should be your watch words. It’s advisable to know how to claim before you need to. That means there shouldn’t be any surprises.

• Find out which documents you can get ready in advance and which ones you’ll need to get hold of. 
• Fill in your claim form fully, accurately and honestly – it’s not worth the risk of withholding any information, how trivial, in case it jeopardises the approval of your claim. 
• Keep in regular contact with your insurer so you can keep each other up to date.
• Make sure you send all the documents you’re asked for, signed as necessary, and keep copies.
• Don’t delay – the faster you do what’s asked of you, the faster your claim can be processed.
• Remember to notify your insurer of any change in your health or employment status, however insignificant it might seem to you.

If in doubt, and you don’t feel able to ask your insurer, you can get professional third-party advice or contact an organisation like Citizens Advice.